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Nathan104

Initially Approved But Now At Quality Review Board?

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I talked to the lady who had been working my initial claim for SSD and she told me a decision had been made. She told me that my claim was approved and I had an effective dat of Nov 05, but it had been picked up by the Quality Review board. It has been with this review board for going on 3 weeks now. She tol me that a certain percentage of cases get picked up for the review board and mine was just one of the picks.

My question is, if my claim was processed and initially approved, what are the chances of that being overturned and it denied? Is it common for this to happen with this review board thing? Im also worried about them changing the effective date as the Nov 05 is the earliest possible date I could have received and is actually 6 months before I even applied for SSD.

Im just paranoid since it is taking so long. Anyone have any experience or heard anything about the review board situation? Thanks.

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Nathan:

Same thing happened to me. I found out later that it really does not have all that much to do with your claim its more of how the person who approved at SSD works. Unless they made a glaring error you are still approved.

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Pete, thanks for the reply. Definitly makes me feel better.

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Pete, thanks for the reply. Definitly makes me feel better.

I agree that you probably don't have anything to worry about. There is a pretty big percentage that are tagged for quality review and very few are ever overturned. And by the way, the review usually takes about 3 weeks so you should hear this week. Now taking bets!!!!

Steve

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My SSA claim went thru the QRB, and I'm told the process is just to make sure that the i's are dotted and the T's are crossed. Once a doctor has stated "creditable" in the medical review, things go fairly fast thru the process. You are lucky in that they decided to award previous to your claim (as the law allows). In my case, they obviously picked a date that allows them to avoid paying retro pay. I had to ask for reconsideration, citing the medical evidence that the doctor said was creditable, and re-request the original date that I had applied for. I have no idea when this process will complete. I'm told that it may take up to three years. At issue is up to about 20k. It would take something really unusual to deny your claim at this point. I got two letters from the SSA during the initial claim process. The first stated that the medical requirements had been met, and the other eligibility criteria were being verified. The second was the award notice. The reason I went thru the SSA disability process was simply that I'm 62, and the additional $508 above what I would have received with SSA "early" retirement is a significant amount of money. Not to mention that the SSA disability medical review cites the very conditions that I'm either currently SC'd for, or have applied for SC for. I also obtained a full copy of my SSA file on CD, (FOIA) and noticed that the award letter in the file did not have a prepaired date, where the actual letter I received did. There were two pages (filled out forms) that were appropriate to send to the VA in support of my current claim. Both together were the SSA equivilent of an IMO based upon medical record review by a currently licensed doctor. The VA will have a hard time trying to discount the information and opinion stated on the forms.

I talked to the lady who had been working my initial claim for SSD and she told me a decision had been made. She told me that my claim was approved and I had an effective dat of Nov 05, but it had been picked up by the Quality Review board. It has been with this review board for going on 3 weeks now. She tol me that a certain percentage of cases get picked up for the review board and mine was just one of the picks.

My question is, if my claim was processed and initially approved, what are the chances of that being overturned and it denied? Is it common for this to happen with this review board thing? Im also worried about them changing the effective date as the Nov 05 is the earliest possible date I could have received and is actually 6 months before I even applied for SSD.

Im just paranoid since it is taking so long. Anyone have any experience or heard anything about the review board situation? Thanks.

Edited by Chuck75

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    • Enough has been said on this topic. This forum is not the proper forum for an attorney and former client to hash out their problems. Please take this offline
    • Peggy toll free 1000 last week, told me that, my claim or case BVA Granted is at the RO waiting on someone to sign off ,She said your in step 5 going into step 6 . That's good, right.?
      • 7 replies
    • I took a look at your documents and am trying to interpret what happened. A summary of what happened would have helped, but I hope I am interpreting your intentions correctly:


      2003 asthma denied because they said you didn't have 'chronic' asthma diagnosis


      2018 Asthma/COPD granted 30% effective Feb 2015 based on FEV-1 of 60% and inhalational anti-inflamatory medication.

      "...granted SC for your asthma with COPD w/dypsnea because your STRs show you were diagnosed with asthma during your military service in 1995.


      First, check the date of your 2018 award letter. If it is WITHIN one year, file a notice of disagreement about the effective date. 

      If it is AFTER one year, that means your claim has became final. If you would like to try to get an earlier effective date, then CUE or new and material evidence are possible avenues. 

       

      I assume your 2003 denial was due to not finding "chronic" or continued symptoms noted per 38 CFR 3.303(b). In 2013, the Federal Circuit court (Walker v. Shinseki) changed they way they use the term "chronic" and requires the VA to use 3.303(a) for anything not listed under 3.307 and 3.309. You probably had a nexus and benefit of the doubt on your side when you won SC.

      It might be possible for you to CUE the effective date back to 2003 or earlier. You'll need to familiarize yourself with the restrictions of CUE. It has to be based on the evidence in the record and laws in effect at the time the decision was made. Avoid trying to argue on how they weighed a decision, but instead focus on the evidence/laws to prove they were not followed or the evidence was never considered. It's an uphill fight. I would start by recommending you look carefully at your service treatment records and locate every instance where you reported breathing issues, asthma diagnosis, or respiratory treatment (albuterol, steroids, etc...). CUE is not easy and it helps to do your homework before you file.

      Another option would be to file for an increased rating, but to do that you would need to meet the criteria for 60%. If you don't meet criteria for a 60% rating, just ensure you still meet the criteria for 30% (using daily inhaled steroid inhalers is adequate) because they are likely to deny your request for increase. You could attempt to request an earlier effective date that way.

       

      Does this help?
    • Thanks for that. So do you have a specific answer or experience with it bouncing between the two?
    • Tinnitus comes in two forms: subjective and objective. In subjective tinnitus, only the sufferer will hear the ringing in their own ears. In objective tinnitus, the sound can be heard by a doctor who is examining the ear canals. Objective tinnitus is extremely rare, while subjective tinnitus is by far the most common form of the disorder.

      The sounds of tinnitus may vary with the person experiencing it. Some will hear a ringing, while others will hear a buzzing. At times people may hear a chirping or whistling sound. These sounds may be constant or intermittent. They may also vary in volume and are generally more obtrusive when the sufferer is in a quiet environment. Many tinnitus sufferers find their symptoms are at their worst when they’re trying to fall asleep.

      ...................Buck
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